Practice Management Software Payment Processing Fees: What IBCLCs Actually Pay

You finish a home visit, open your laptop on the kitchen counter while the baby finally settles, and run the card on file. The portal says the $200 visit is paid. Two days later it lands in your bank account as $193.40.

That $6.60 is your payment processing fee. You expected to pay something. Visa and Mastercard, the FSA and HSA cards parents reach for, the fraud checks, the convenience of a stored card all cost money. Card processing is a normal, unavoidable cost of running a private practice.

What's worth a closer look is how that $6.60 breaks down. On most platforms, about $6.10 of it is the payment processor's standard rate. The other $0.50 or so is an extra percentage your practice-management software can add on top, its own cut of the sale. On one visit that markup is pocket change. Across a year of visits, packages, and balances it adds up, and it's one of the few software costs you can change without changing how you practice.

The number to look for is the percentage on every transaction

Two figures anchor this whole conversation.

SimplePractice's support documentation lists an online payment "integration fee" of 3.15% + $0.30 per successful transaction. It applies to all major credit and debit cards, including FSA and HSA cards, whether you charge the card at the time of service or store it for later. SimplePractice publishes this rate in its own support docs, so it's disclosed, not buried. (More on that below.)

Stripe, the processor underneath a great many of these platforms, lists a standard U.S. domestic card rate of 2.9% + $0.30 per successful transaction.

The fixed $0.30 is identical. The difference is the 0.25 percentage points added to the sale amount. That's the platform markup, the slice that goes to the software company rather than the card networks.

A quarter of a percent is genuinely small per visit, and you shouldn't panic about it. But it runs on every dollar a patient pays you through that platform, so it's worth seeing the real figures before you decide it doesn't matter.

What 0.25% becomes over a year of patient payments

The reason it's easy to dismiss is the reason it's worth doing the math: one transaction looks harmless. The cost only shows up when you annualize it, and that depends on how many payments you actually run.

A steady solo cash-pay practice runs somewhere around 8 to 15 visits a week, the range we landed on in TLN vs. direct-bill vs. cash-pay, which works out to roughly 35 to 65 card payments a month. At $200 a payment, the 0.25% markup comes to about $18 to $33 a month, or $210 to $390 a year. A newer or part-time practice seeing a few patients a week is more like $50 to $100 a year. A thriving full-time practice, a package-heavy one selling $400 to $600 bundles, or a two-provider office can clear $500 and up, since the markup is a percentage and the volume rises with it.

So let's be clear about what this is and isn't. A few hundred dollars a year is not a reason to abandon a platform you otherwise like. It's a smaller line item than the template packs and setup time that already make a generic EHR cost more than its sticker price (we did that math separately). But it's real money leaving your practice every month, for nothing your patients can see or feel. And unlike rent or your credential renewal, you can change it by choosing differently.

How other practice platforms compare

SimplePractice is a useful example because it's widely used and publishes its rate, but it isn't the whole market. Most practice-management platforms run payments through Stripe or a similar processor, and their card rates land in a fairly narrow band. Here's where a few of the platforms IBCLCs actually shop list their standard online card rate, as published in mid-2026:

("Not listed" means the platform doesn't prominently publish that rate, not that the method is unavailable. Confirm directly.)

A few things stand out. Most platforms sit right around Stripe's 2.9% baseline, and Jane actually lists a hair below it, which is the clearest proof that a practice platform doesn't have to add a markup at all. SimplePractice's 3.15% is on the higher end of the range. And the headline percentage isn't the whole cost: PracticeQ, for example, adds a $7.50 monthly PCI fee on top of its per-transaction rate, and ACH rates and caps differ from one platform to the next.

None of this makes any of them a bad product. They're all established tools, and the right fit depends on far more than payment rates. The narrower point is that when you compare them, weigh the real payment economics, not just the monthly sticker price, and confirm each number against the platform's own current documentation, because these rates change.

"Hidden fees" is what people search, but this fee isn't hidden

If you've been comparing software, you've probably typed something like "SimplePractice hidden fees" or "SimplePractice Stripe fees" into a search bar. A lot of people do. The phrasing makes sense, because the processing rate isn't the headline number on a pricing page. The monthly subscription is.

But here's the honest version: SimplePractice discloses its 3.15% + $0.30 rate in its own support documentation. It isn't hidden, and it isn't improper. It's a normal, published platform markup, and SimplePractice is a solid, well-supported product that plenty of allied-health practices use for good reasons. Calling a disclosed fee "hidden" is just inaccurate.

What is worth your skepticism is how hard the rate is to pin down from third-party sources. SimplePractice's current rate is 3.15% + $0.30, but plenty of comparison articles and review sites still cite an older 2.7% + $0.30 figure. When the blogs reviewing a platform can't agree on its rate to within half a percent, that's the real lesson.

So don't treat a number from any article, including this one, as your operative figure. Confirm your own current rate, in writing, from your platform's billing settings or support docs before you sign or switch. Rates change. The disagreement between sources is the proof that you have to check.

The cheaper rail most articles skip: ACH

Here's the part most "payment fees" articles leave out, and it's the one that can save a package-heavy lactation practice the most. Not every payment has to be a card.

Card networks are expensive because of the infrastructure, rewards, and fraud risk behind them. Bank transfers (ACH, in the U.S.) ride completely different rails and cost far less. Stripe's ACH Direct Debit runs 0.8%, capped at $5.00 per transaction, against 2.9% + $0.30 with no cap on cards. On a small visit fee the savings are modest. On the larger payments common in lactation practice, like multi-visit packages, prenatal bundles, and payment plans, the gap is striking, and the cap means a big payment can never cost more than five dollars to collect.

The catch is that ACH is slower. It settles in about three to five business days, and not every platform exposes it, so it's no help for collecting at the end of a home visit. But for invoiced packages, payment plans, and any large balance where the parent isn't standing in front of you, offering "pay by bank" next to "pay by card" is the biggest single lever you have on processing costs. If a platform you're evaluating only supports cards, or won't let you decide which methods to accept, that's a real limitation worth naming.

Integrated payments are genuinely worth something

There's a fair counterargument to all of this, and skipping it would be dishonest.

A higher integrated rate buys you a workflow that mostly takes care of itself. With an external, cheaper processor, you can end up doing a little dance every time: charge the card in one tool, wait for confirmation, flip back to your practice software, mark the invoice paid by hand, then at month-end reconcile the processor's report against your books and track down the payments that failed or got recorded twice. That work isn't free either. It costs evenings, and it costs the occasional accounting error that takes an hour to untangle.

Plenty of seasoned IBCLCs look at that and decide the extra 0.25% is the right trade for clean books, one screen, and no reconciliation. That's a completely valid choice, and for a lot of practices it's the correct one. Integrated payments save real time, and time is the scarcest thing in a solo practice.

So the mistake isn't paying for integration. It's letting the comparison stop at "does this software take card payments?" when the better question is "what does my whole payment workflow cost me, counting the software fee, the processing fee, the platform markup, and my reconciliation time, and is that markup buying me something I actually use?" Provider-aligned software should make the fee structure obvious enough that you can answer that without emailing support.

Five questions before you commit to a payment setup

When you compare practice-management tools, five questions separate a transparent setup from an expensive one:

1. What's the exact card rate, percentage and fixed fee? Get the current number from the platform itself, not a review site.
2. Is that the processor's published rate, or a platform-specific one? If it's higher than the underlying processor's standard rate, the gap is the platform markup. Ask what it buys you.
3. Who owns the payment account? Is it your connected Stripe (or other processor) account, with money landing directly in your bank? Or a platform-controlled account that the money passes through?
4. Can you choose which payment methods to accept, and does it support ACH? Bank payments are where package-heavy practices save the most, and Apple Pay or Google Pay can speed up collection at the visit.
5. Does the platform take any extra cut of patient payments? Keep this separate from the monthly subscription, per-claim fees, SMS charges, and other add-ons, so you're comparing like for like.

The right answer isn't always "lowest fee." A bargain processor that forces duplicate data entry can cost more in time and errors than it saves in cents. But you can't make that trade well if you don't know which part of the fee is the processor and which part is the platform.

Two caveats that protect you (and your patients)

On surcharging. A reasonable instinct is to pass the card fee to the patient by adding a small percentage at checkout, so the cost comes out of their pocket instead of yours. Be careful here. Surcharging is outright illegal in a few states (Connecticut, Massachusetts, Maine, and Puerto Rico) and tightly restricted by card-network rules everywhere else: a cap of around 3%, mandatory disclosure on signage and receipts, and a flat ban on surcharging debit cards anywhere in the country. This isn't a place to wing it. Before you add any card surcharge, check your state's law and your processor's rules, and disclose it clearly. For most small lactation practices, building the cost into the visit fee, or steering large balances to ACH, is cleaner than surcharging.

On taxes. Card processing fees are generally a deductible business expense for a sole proprietor or LLC practice, which softens the real cost a bit. That's general information, not tax advice, so confirm the specifics with your accountant.

Why this lands harder for lactation than for most specialties

IBCLC private practice runs on thin, leaky margins, and a payment markup lands on top of leaks you're already absorbing.

Cash-pay parents are often paying you out of pocket while they wait on a superbill reimbursement that may never fully come through. Insurance-routed visits frequently pay less than the clinical time honestly requires. Home visits bury an hour of unbilled drive time, prep, charting, and pediatrician follow-up inside every "60-minute" appointment. (We broke that per-hour reality down in TLN vs. direct-bill vs. cash-pay.) No-shows happen. Supplies and travel come out of your pocket.

Against that backdrop, a recurring percentage skimmed off the top of every payment isn't a rounding error. It's one more line standing between the work you did and the money that reaches your bank account. For a $200 visit, $0.50 is nothing. For a year of visits, packages, and balances, it's a number worth seeing clearly, because it's one of the very few you can actually change.

How NuBloom handles payments

NuBloom is built around your own connected Stripe account. You connect Stripe from practice settings in a few minutes, patients pay through the portal or a payment link you send, and the money goes straight to your bank account. Nothing passes through us.

Because the Stripe account is yours, you control your own payment intake. You decide which methods to accept and turn them on from your own Stripe dashboard: cards, Apple Pay and Google Pay for fast collection at the visit, and ACH bank payments for the big packages and payment plans where the capped 0.8% rate saves the most. You're not locked into one platform-set rate, or one fixed menu of payment methods.

And NuBloom doesn't add its own percentage on top of Stripe's processing. That doesn't mean payments are free. Stripe still charges its standard rate (2.9% + $0.30 on standard U.S. cards), and that's true on any platform. It means there's no markup stacked on top of it, and no slice of the payment routed back to us. In our terms, NuBloom isn't a party to the financial transaction between you and your patient. We'd rather charge clearly for the software, $59 a month with messaging, reminders, templates, and analytics included, plus $39 a month for each additional billable seat (billing and read-only team members are free), and leave your payment processing alone.

That's the whole idea: price the software honestly, keep the payment math transparent, and let you keep more of what you earned. For a feature-by-feature look at how this compares to a tiered platform, see NuBloom vs. SimplePractice or the full pricing breakdown.

Before you switch anything, do the whole math

Don't move platforms over fifty cents a transaction. That's the wrong lesson, and switching has its own real costs, including rebuilding the templates and workflows you've already set up, as any IBCLC starting in private practice learns quickly.

Do the whole calculation instead:

• monthly subscription and per-provider seats
• card processing rate (the part that's processor vs. platform markup)
• ACH availability, rate, and cap for your larger payments
• per-claim fees, SMS and reminder costs, template setup
• reconciliation time and billing workflow
• offline charting, if you do home visits

Then pick the platform that actually fits the way your practice earns money. For some clinicians, a higher integrated rate is worth every cent for the clean books. For others, especially cash-pay and package-heavy practices, even a small extra percentage on every payment is the wrong kind of recurring cost. The point is to know which one you are before every patient payment starts running through it.

If you want to see what a no-markup setup feels like in practice, you can try NuBloom free for 14 days, no credit card to start.

Frequently asked questions

How much does SimplePractice charge for payment processing?

SimplePractice lists an online payment integration fee of 3.15% plus $0.30 per successful transaction, and it applies to all major credit, debit, FSA, and HSA cards. That rate is disclosed in SimplePractice's own support documentation. For comparison, Stripe's standard U.S. domestic card rate is 2.9% plus $0.30, so the difference is about 0.25 percentage points on each sale, which is the platform's markup.

Why are practice management software payment fees higher than Stripe's rate?

Most practice platforms process payments through Stripe or a similar processor, then add a small percentage on top, often called an integration fee. That extra slice goes to the software company, not the card networks. The amount varies: many platforms sit right at Stripe's 2.9% baseline, and some, like SimplePractice at 3.15%, run a quarter point or more above it. The only way to know your real rate is to confirm it in your platform's billing settings.

Can I use my own Stripe account with practice management software?

With some platforms, yes. NuBloom, for example, connects to your own Stripe account, so payments land directly in your bank and you control which methods you accept, including cards, Apple Pay, Google Pay, and ACH bank payments. Because there's no platform markup added on top, you pay Stripe's standard rates directly. Other platforms use a managed payment account and set their own integration fee, so it's worth asking who owns the account before you commit.

Is ACH cheaper than credit cards for collecting patient payments?

Usually, for larger payments. Stripe's ACH Direct Debit runs about 0.8% capped at $5.00 per transaction, versus 2.9% plus $0.30 with no cap on cards. On a $600 package that's roughly $4.80 by bank transfer instead of $17.70 on a card. The tradeoff is that ACH settles in about three to five business days, so it fits invoiced packages and payment plans better than collecting at the end of a visit.

Can lactation consultants pass credit card fees on to patients?

Be careful, because surcharging is regulated. It's outright illegal in a few states, including Connecticut, Massachusetts, Maine, and Puerto Rico, and card-network rules restrict it elsewhere with a cap of around 3%, disclosure requirements, and a flat ban on surcharging debit cards anywhere. Before adding any card surcharge, check your state law and your processor's rules and disclose it clearly. For most small practices, building the cost into the visit fee or steering large balances to ACH is simpler.

Sources

• SimplePractice: Processing online payments (3.15% + $0.30 online payment integration fee)
• Stripe pricing (2.9% + $0.30 standard U.S. cards; 0.8% ACH Direct Debit, capped at $5)
• Jane: Understanding your payment processing fees (2.85% + $0.25 online, 2.6% + $0.10 in person)
• PracticeQ / IntakeQ Payments fee breakdown (2.9% + $0.30; 1% ACH, $10 cap; $7.50/month PCI fee)
• Healthie: card payments FAQ (2.9% + $0.30)

NuBloom is practice management software built for lactation consultants. Lactation-specific charting, scheduling, billing, and messaging, with offline mode for home visits and payments through your own Stripe account. Try it free. Verify any rate against your platform's current documentation before acting on it.